No abstract

Stroke is the second leading cause of death globally and accounts for an estimated 5.5 million deaths each year worldwide. [1] Revascularization of the carotid artery is one of the key procedures to reduce the incidence of stroke. Chronic total occlusion (TO) and near-total occlusion (NO) of the carotid artery are rare. Treatment for TO and NO is controversial with potential complications, including periprocedural stroke, intracranial hemorrhage, and carotid-cavernous fistula (CCF). [2] There have been attempts to implement carotid artery endarterectomy (CEA) and endovascular treatment, but the success rates were far from satisfactory. For patients with TO, the success rate of revascularization is around 40% and 60%, respectively, for CEA and endovascular technique. [3] For patients with NO, the morbidity and mortality rates are 3% and 9%, respectively.We attempted hybrid procedures to improve the revascularization rate. Issues with the suitability of these procedures were addressed by considering intraprocedural complications, 30-day morbidity and mortality, and longterm morbidity and mortality.

Background and purposeLow-profile intracranial stents such as the LEO Baby stents are considered to be advantageous for the treatment of intracranial aneurysms originating from small arteries. This study aimed to evaluate the initial and mid-term clinical and angiographic results of LEO Baby stents in stent-assisted coiling of intracranial aneurysms with small parent arteries (<2.5 mm).MethodsWe performed a retrospective study to identify 131 patients with aneurysms arising from small parent arteries treated with Leo Baby stent-assisted coiling in a single institution between October 2018 and June 2021. We assessed the immediate and progressive aneurysm occlusion rates, procedure-related complications, and clinical outcomes.ResultsA total of 131 patients with 135 aneurysms were identified, including 65 (48.1%) cases of acutely ruptured aneurysms. Technical success was achieved in all cases (100%). The immediate angiography showed complete occlusion in 111 aneurysms (82.2%), neck remnants in 19 (14.1%), and residual sac in 5 (3.7%). Procedure-related complications occurred in 14 cases (10.3%), including 13 (9.6%) thromboembolic complications and 1 (0.7%) hemorrhagic complication. Six-month follow-up angiography was achieved in 106 (78.5%) aneurysms, which showed complete occlusion in 102 (96.2%) aneurysms, neck remnants in 2 (1.9%), and residual sac in 2 (1.9%). Clinical follow-up was available in all patients with a median duration of 6.8 months, and favorable clinical outcomes (modified Rankin Scale score: 0–2) reached 91.6%. The mortality rate was 4.6%.ConclusionOur results demonstrate that stent-assisted coiling of intracranial aneurysms located on small arteries using LEO Baby stents is technically feasible, highly effective, and has midterm durability in aneurysmal occlusion.